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Position statement

The dangers of dieting in adolescence

Posted: Oct 23, 2025

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Principal author(s)

Megan E Harrison MD, Ashley Vandermorris MD MSC, Ellie Vyver MD, Allison Rodrigues MD, Holly Agostino MD, Amy Robinson MD, Alene Toulany MD MSC; Canadian Paediatric Society, Adolescent Health Committee

Abstract

Dieting is a common occurrence during adolescence. Dieting behaviours and cognitions can have a profound impact during this critical period of development, when youth have a heightened sensitivity to appearance and are actively forming their body image. Adolescents are particularly susceptible to internalizing the myriad and conflicting “health” messages disseminated through mainstream and social media, peer interactions, family dynamics, school systems, and health care encounters. These messages can influence their perception of what constitutes a “normal” or “healthy” body, motivating dieting behaviours that are undertaken in an attempt to change their body weight or shape (or both). 

Keywords: Adolescent dieting; Body image; Disordered eating

Introduction/Background

Over two decades of evidence demonstrates a notable portion of Canada’s children and adolescents experience dissatisfaction with their weight[1]-[6]. Pre-adolescents report a desire to be thinner[7] and at least a third of females aged 10 to 14 in Canada are dieting and using extreme weight control behaviours at any given time[6][8]. By grade 8, more than 50% of teens have attempted to lose weight in some way despite the majority of these young people being at a healthy weight[6][9]. Attempts to change body weight increase with age[6][10]. 

Amid growing awareness of the overall health impacts of childhood weight-related disorders, such as obesity and eating disorders, practitioners play a vital role in prevention, screening, and management of behaviours known to predispose youth to these conditions, including dieting[11][12]. For some adolescents, dieting may lay the groundwork for an enduring unhealthy relationship with food, irrespective of their initial body shape or weight.

Additionally, it is increasingly recognized that adolescents often experience weight bias (defined as negative assumptions about a person based on appearance, body shape and/or weight) from peers, parents, teachers, and health care providers. This bias can lead to adverse psychological, social, academic, and physical health consequences[13].

This document updates Canadian Paediatric Society recommendations on the dangers of dieting in adolescence[14] and should be read and used alongside this CPS statement from the Adolescent Health Committee on managing paediatric eating disorders in community practice[15].

Complexities of dieting

The term “dieting” has diverse interpretations among young patients, families, and health care providers. Generally, the term implies an intentional, often temporary, modification of eating habits, frequently undertaken to achieve weight loss or alter body shape[7][11].An adolescent who states they are “on a diet” may align their choices with currently published nutrition recommendations[16], such as increasing fruit, vegetable, and whole grain intake, whereas another teen may adopt concerning behaviours, such as prolonged fasting or disordered eating, to exert control over their weight[17]. Addressing dieting is complicated by the biases held by individuals, including health care providers.

While some adolescents begin dieting with a goal of becoming “healthier”, most cite body image dissatisfaction and a desire for a slimmer physique as their primary motives, rather than focusing on overall health[11]. For many, perceptions of being “healthier” are shaped by both media and messaging from family, peers, teachers, and health care providers, which in any combination can propagate the notion that being thinner is synonymous with being healthier. Such perceptions can then lead to a shift in goals: from cultivating healthy habits, like increasing fruits and vegetable intake, to focusing specifically on weight loss and becoming slimmer.

Large cross-sectional studies[17]-[21] demonstrate that prolonged fasting, skipping meals, following fad diets (such as using a “cleanse”)[10] and over-exercising[22] are the most frequent weight control practices among children and adolescents, followed by self-induced vomiting and substance use (i.e., nicotine) to control weight. While comparing studies on dieting status and degrees of dieting is challenging due to variable definitions, practicing self-induced vomiting, prolonged fasting, skipping meals, adhering to fad diets, bingeing, and laxative or diet pill use are consistently characterized as dangerous or extreme dieting[11][20][21][23]. The term “disordered eating” is used when dieting behaviours put an individual at considerable risk without currently meeting the diagnostic criteria of an eating disorder[18].

Risk factors for dieting

Determining the factors that contribute to dieting is complex because diverse intersectionalities—such as socioeconomic status, religion, ethnicity, sexual orientation, and gender identity—may influence an adolescent’s body satisfaction and, thus, their potential engagement in weight-altering practices. 

Psychosocial factors have been reported to influence body dissatisfaction and weight control intentions. In general, dieting and disordered eating behaviours in Canadian adolescents increase with age and are more prevalent among those identifying as cis-female or gender diverse[6]. Females often feel pressure to lose weight and be thinner, while males often perceive pressure to gain muscle and be larger[24]-[27]. Dieting in adolescent males may be under-recognized because there may not be a history of weight loss due to the tendency to focus on gaining muscle mass. Also, low self-esteem is a strong risk factor for dieting even when controlling for body mass index (BMI)[9][18][28]-[30]. Weight concerns and weight importance in adolescence are predictive of continued dieting and disordered eating into young adulthood[31].

Adolescents considered overweight or obese are at higher risk of engaging in dieting and disordered eating behaviours as compared with non-overweight peers[12][17][32]. Parental criticism of a child’s weight, family pressure to diet, and parental role modelling of dieting are further associated with increased dieting rates and increased risk of extreme dieting behaviours that can persist into adulthood[33]-[38]. Parental views and discourse around weight are linked with the development of adolescent obesity and eating disorders[39]-[42]. Praise for weight loss in adolescents who are overweight or obese may inadvertently encourage unhealthy practices[12].

It is also important to note the high prevalence of dieting regardless of weight status[43][44], suggesting that other societal factors may be at play. For instance, disordered eating and unsafe weight control behaviours, such as binge eating, overexercising, purging, and extreme nutrition restriction may be unintentionally encouraged by weight-oriented approaches to dietary counselling taught at schools, via public health, and in health care settings[12]. Internalization of the “thin ideal” or “toned ideal” (or both) and perceived pressures to lose weight or gain muscle are associated with poor body image regardless of BMI and are highly predictive of dietary restriction in males and females[31]. Body image concerns are common among adolescents, and ample research has shown that adolescents less satisfied with their bodies are more likely to engage in restrictive diets regardless of weight status[39][43][44]. Also, “fad diets” and popular diets that restrict certain groups or types of foods (such as “clean eating”, paleo, or keto diets) promote dichotomous thinking around food and are associated with disordered eating. Labelling foods as “good” versus “bad” appears to impede internal regulators of appetite and satisfaction and promotes disordered eating[12][45][46].

Practitioners must explore methods of weight loss and any associated symptoms with all children and youth they see with sudden changes in their weight, to screen for and act upon unsafe dieting behaviours and eating disorders among all body sizes. For examples of screening questions for adolescent eating disorders and disordered eating[47], see this CPS statement.

As avid consumers of digital and social media, adolescents are exposed to ubiquitous messaging related to food, body image, and weight. The surge in digital and social media use has been linked both to increasing adolescent consumption of processed foods (believed to be due to direct marketing to teens)[48] and to body image effects. The potential influences of social media on adolescent body image (both positive and negative) is a complex and emerging area of research, with multiple moderating variables at work[49]. A growing body of evidence suggests a linkage between high levels of social media use and body image disturbance[50][51] and eating concerns (dieting, restrictive eating, and overeating)[52]. A particularly significant association between social media use and disordered eating cognitions and behaviours is found in younger adolescents[50]. Recognizing this nuanced relationship between social media and adolescent well-being is crucial for fostering a healthier digital environment and supporting positive body image development.

Table 1 summarizes socio-ecological factors that can influence risk for dieting and unhealthy weight control behaviours[20][27][28][48]-[80].

Table 1. Correlates associated with dieting and unhealthy weight control behaviours in adolescents
Individual-level factors
  • Age and gender
  • Weight
  • Body dissatisfaction
  • Psychological attributes (low levels of self-esteem, even when controlled for body mass index, and lower sense of control, self-concept, and self compassion)
  • Chronic health conditions

  • Physical (e.g., asthma, diabetes, celiac disease) and mental health (e.g., depression, anxiety)[53]-[57]

  • Early puberty[58][59]
  • Special diets (e.g.,“keto”, “paleo”)
  • High-risk behaviours (substance use, unprotected sex, illegal activities)[20][28][60][61]

Family/community-level factors

  • Parental modelling (body dissatisfaction, dieting)
  • Religion and culture (i.e., cultural and religious body ideals) 

Environmental-level factors

  • Weight-related bullying (particularly commonly experienced in Black, Indigenous, and people of colour [BIPOC] youth and those living with lower socioeconomic status)[62]-[67]
  • Peer influence (all genders)[27][68]-[74]
  • Involvement in weight-focused sports or experiencing weight-related maltreatment in sport (regardless of specific sport)[75]-[79]
  • Social media (impacts both body image and food choices, with a particularly strong association between social media use and poor body image and disordered eating cognitions and behaviours in younger adolescents)[48]-[52][80]

Consequences of dieting

Adolescence is a time of profound physical and psychological growth, when optimal nutrition and health are critical. Children and adolescents who engage in dieting may perceive their actions to be proactive and beneficial, but dieting can be counterproductive for weight management in these populations. While most teenagers who engage in dieting may not experience adverse effects immediately, their actions can expose them to considerable health risks and minimal tangible benefits. Dieting behaviours in this population are associated with an increased risk for binge eating and subsequent weight gain over time, regardless of baseline weight status or sex[32][81]. Unfortunately, few studies have examined the breadth and prevalence of possible negative consequences because most dieting in teenagers occurs in unstructured ways, and decisions regarding dietary changes are haphazard and often short-lived. Therefore, a truly comprehensive understanding of the long-term implications of adolescent dieting remains elusive.

Physical consequences

The unique dietary needs of adolescents, to support puberty, growth, and development (physiological and neurocognitive), make the potential for negative physical health effects of dieting particularly concerning[82]. Nutrient and mineral deficiencies (notably iron and calcium), can pose short- and long-term health risks. Even marginal reductions in energy intake in growing children and teenagers can lead to growth deceleration[83][84]. Restrictive dieting is also associated with poorer macronutrient intake[85], with adolescents who engage in extreme weight control behaviours (such as vomiting or using diet pills) exhibiting lower consumption of fruits and vegetables and higher intake of high-fat foods compared with peers who do not diet[86].

Disordered eating, even in the absence of substantial weight loss, has been found to be associated with menstrual irregularity, including secondary amenorrhea[87]-[89]. Concerns also extend to long-term risks for osteopenia and osteoporosis in dieting girls, even in the absence of amenorrhea[90][91]. The medical complications associated with purging behaviours, such as self-induced emesis, laxative use, or diuretic use, are well established, as are the risks associated with stimulant weight loss medications[92][93]. Moreover, evidence suggests that dieting among preadolescents and adolescents often results in paradoxical weight gain over time, potentially leading to physical consequences of excess weight. For example, a large prospective study involving over 15,000 children (9 to 14 years old) found that dieters gained significantly more weight than matched non-dieters[32]. Similarly, a 10-year longitudinal study examining eating habits in adolescence found that dieting and unhealthy weight control behaviours predicted higher BMI in adulthood, independent of BMI in adolescence and adulthood[81]. Notably, skipping meals, fasting, restricting intake, using food substitutes (for males), and using diet pills (for females) during adolescence were behaviours associated with the largest BMI increases 10 years later for both females and males[81].

Psychological consequences

The short- and long-term psychological effects of dieting and food restriction on adolescents remain largely unknown. While studies in adults suggest that chronic dieting is associated with a variety of symptoms, including food preoccupation, distractibility, irritability, fatigue, and a propensity to overeat and binge eat[94], it is uncertain whether these effects extend to children and youth. However, there is evidence that the developing brain in children and adolescents is more vulnerable in general at this stage of life. An assumption that the same is not possible and/or amplified in children and youth would be remiss, particularly in light of evidence of increased rates of eating disorders among Canadian youth[95]-[97]. Such symptoms could have serious implications for the rapidly evolving social and psychological development of adolescents. Many lifestyle habits are established during this period, and habitually restricted eating could, potentially, have lifelong implications toward dysfunctional eating patterns.

It is acknowledged that teenagers with lower self-esteem are more inclined to diet, often with hope of improving self-perception through successful weight loss[9][18][28]-[30]. However, the process of dieting can further diminish a young person’s self-esteem. During childhood and adolescence, self-esteem is partially defined by achievements and setbacks, making the negative impact of dieting, particularly when less successful, a crucial consideration.

Furthermore, the relationships between dieting, disordered eating, and eating disorders warrant attention. Dieting frequently precedes onset of eating disorders such as anorexia nervosa and bulimia nervosa. In prospective studies, dieting was associated with increasing risk for developing an eating disorder between five- and 18-fold[14]. It is challenging, however, to ascertain whether dieting causes, triggers, or represents a prodromal stage of illness.

Dieting and unhealthy weight control behaviours have also been linked with depressed mood. Fasting and skipping meals is correlated with depressed mood[23], and dieting has been associated with depressed mood in both boys and girls, independent of weight[44]. The relationship between low mood and dieting may be bidirectional. Young people with depressed mood may be more likely to engage in dieting or unhealthy weight control methods, while dieting and caloric restriction can lead to depressed mood and poor mental health. This relationship underscores the complex interplay between dieting behaviours and psychological well-being. Adolescents may turn to dieting as a coping mechanism for managing negative emotions or as a response to societal pressures, which can exacerbate feelings of depression and reinforce a cycle of disordered eating and deteriorating mental health. Furthermore, research indicates that adolescents who engage in dieting and unhealthy weight control behaviours are at higher risk for developing suicidal behaviour in adulthood. This association highlights the serious implications of dieting for mental health and underscores the need for comprehensive interventions that address both the physical and psychological aspects of disordered eating[98].

Caloric restriction also has cognitive impacts[99]. Adults in a semi-starved state are known to have decreased concentration, comprehension, and judgment capabilities[100], while neuroimaging studies in anorexia nervosa reveal brain volume deficits that can partially recover with weight gain[101][102]. While this research has limited generalizability to adolescents who diet, it suggests there are biochemical and physiological links between dietary intake and mood that warrant further investigation in all age groups[103].

Health at every size

Healthy individuals come in all shapes and sizes, and it is imperative to recognize that healthy versus unhealthy habits should not be assumed based solely on appearance. Research has advanced our understanding of overall health, highlighting that weight and BMI are in themselves insufficient indicators of health status. For instance, deficiencies in essential nutrients such as iron, calcium, and vitamin D are observed across a spectrum of weight categories, including underweight, normal weight, and overweight adolescents[104]. Research also shows that adults with higher BMIs do not necessarily exhibit low cardiovascular fitness, challenging the notion that weight alone dictates healthy heart function[105][106].

Individual weight status is influenced by a myriad of factors beyond mere energy intake and physical output. This complex interplay involves genetic, socio-economic, environmental, metabolic, and behavioural factors[107]. Elements including the social determinants of health, stress, mental health, access to a variety of food choices, nutrition quality, sleep hygiene, medication side effects, and other biological and psychosocial factors influence weight and body shape. An emerging shift in focus is underway toward promoting healthier habits rather than fixating on weight loss or numerical values. Adults with positive weight satisfaction report more positive health behaviours and have better health status irrespective of BMI[108].

Children and youth are frequently exposed to negative views of overweight and obesity, known as ‘weight stigma’, across various spheres of life including interactions with peers, family members, educators, and health care providers[109][110]. Weight bias, including among paediatric health care providers, is not uncommon, and evidence suggests that it can have detrimental effects on patient health[63][110][111]. For example, children and youth who encounter weight stigma in a health care provider may delay or avoid seeking care, which can negatively affect overall health and later outcomes[63][107]. Also, youth with high body weight who experience weight stigma are at higher risk for poor physical health consequences (including disordered eating, lower physical activity, substance use, and weight gain), psychological distress (e.g., depressive symptoms, low self-esteem, and suicidal ideation), and poor social and academic outcomes[13][107][110]. Such associations underscore the importance of health care provider awareness of their own biases and the need to avoid contributing to stigmatization.

While weight management practices and treatments are beyond the scope of this statement, it is essential to acknowledge that successful health behaviour and lifestyle programs for paediatric obesity share common strategies with eating disorder programs. These family-based programs promote healthy and varied food consumption, encourage physical activity for enjoyment, and enhance self-esteem and body image[112]. Although self-guided dieting in children and adolescents is linked to high risk for disordered eating and other negative outcomes[12], supervised, comprehensive, and multidisciplinary weight management programs may mitigate such risks[113].

Summary and recommendations

Weight and body dissatisfaction are common experiences for children and teenagers in Canada. Behaviours to control weight are prevalent and exist on a spectrum from healthy to potentially dangerous. Dieting, disordered eating behaviours, and body dissatisfaction often precede the onset of eating disorders, obesity, or both. Dieting can lead to serious physical and psychological sequelae and often has the paradoxical consequence of compounding weight gain over time. Health care providers (HCPs) can be a source of weight bias and practitioners are reminded that weight alone cannot infer health status.

Recommendations for paediatricians and other HCPs are as follows:

  1. At all routine appointments with adolescents and their caregivers, apply a ‘health at every size’ lens and encourage healthy, safe, and sustainable lifestyle behaviours, rather than focusing on weight.
  2. Take time and space to self-assess and reflect on attitudes and assumptions about body weight that may be informing care and practice. Self-awareness and training can help alleviate and avoid weight bias.
  3. Instead of identifying foods as “bad” or “good” during nutrition counselling, encourage balanced and normalized eating with adolescents of all body sizes, with focus on variety in food consumption at regular intervals throughout the day. Canada’s Food Guide is a helpful resource.
  4. Discourage restrictive eating with adolescents. Highlight that they have different nutritional and energy needs than adults. Restrictive eating can include any diet that limits quantity, variety, type or frequency of food intake, and may lead to a micronutrient, macronutrient, or energy deficiency and promote the dichotomous thinking about food associated with disordered eating.
  5. Screen for supportive food and eating environments in the home, starting with parents and families when children are young as part of preventative care.  
  6. Discourage parents, caregivers, and other family members from discussing their own weight loss or diet goals with children and youth, and from encouraging children to diet.
  7. Screen routinely for recent changes in eating habits as part of quality preventative care for adolescents, regardless of body size. When restrictive diets are present, provide targeted nutrition counselling. If weight changes are identified, explore the method(s) used and take care not to inadvertently praise or encourage unhealthy weight control behaviours. When there are concerns regarding a possible eating disorder, prompt referrals should be made. See this CPS statement for how to assess medical stability in adolescents with weight loss.
  8. Support adolescents who are overweight or obese toward adopting healthy and sustainable lifestyle practices (i.e., social rather than solitary physical activities, sleep hygiene, mental health hygiene), rather than focusing on weight loss. Where available, referral to an interdisciplinary paediatric obesity program may benefit some adolescents.
  9. Advocate for school-based curriculums, programs, or activities that encourage inclusive, weight-neutral, and evidenced-based messaging on healthy lifestyle choices and routines, including eating patterns. Collaborate with educators to provide resources and training that promote positive health behaviours over weight-focused messaging.

Acknowledgements

This position statement was reviewed by the Community Paediatrics and Nutrition and Gastroenterology Committees of the Canadian Paediatric Society.

CANADIAN PAEDIATRIC SOCIETY ADOLESCENT HEALTH COMMITTEE (2024-2025)

Members: Megan E Harrison MD (Chair), Ellie Vyver MD (Past Chair), Ayaz Ramji MD (Board Representative), Alene Toulany MD MSC, Holly Agostino MD, Ashley Vandermorris MD MSC, Amy Robinson MD, Chris Kobylka-Pang MD (Resident Member)
Liaisons: Allison Rodrigues MD (CPS Adolescent Health Section)
Principal authors: Megan E Harrison MD, Ashley Vandermorris MD MSC, Ellie Vyver MD, Allison Rodrigues MD, Holly Agostino MD, Amy Robinson MD, Alene Toulany MD MSC

Funding
There is no funding to declare.

Potential Conflict of Interest
Dr. Amy Robinson reported receiving funding from the Royal College of Physicians and Surgeons of Canada through Fatigue Risk Management Grant. No other disclosures were reported.

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